management and operation technique

1. Anne Saputra
GASTRIC PERFORATION

2. ANATOMY
 GASTER-> GIT placed
between oesophagus and
duodenal.
Cardia
Fundus
Corpus
Pyloric

3. VASCULARISATION
Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.

4. Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.

5. INNERVATION
Skandalakis L.J., 2014. Surgical Anatomy and Technique. 4th ed. Springer. New York

6. ANATOMICAL LAYER
1. MUCOSE
2. SUB-MUCOSE
3. MUSCULARIS
4. SEROUS
Sherwood L. 2008. Gaster Anatomy in Human Physiology From
Cells to System. Seven Edition. Brooks Cole. p. 636-639.

7. EPIDEMIOLOGY
 2-10% Peptic ulcer -> Perforation
 MALE > FEMALE; trend geriatric, NSAID
long term used, life style environment
 Etiology :
1. Non-trauma : H. pylori, NSAID, stress,
gastrinoma, cigar-alcohol
2. Abdominal Trauma : Blunt,
penetrating
American College of Gastroenterology. Ulcers and Gastrointestinal Bleeding:

8. Tortora G.J., Derrickson B.H. 2010. Principles of Anatomy and Physiology: The Digestive System. Twelve Edition.
Wiley. p. 134-136.

9. PATOPHYSIOLOGY
Kumar et al., 2014. Robbins Basic Pathology. 9th ed. Elsevier. New York

10. GASTROPHATY NSAID

11.  Classification by.
Modifed Johnson’s:
 Tipe 1. (55%) Proximal
corpus and anthrum
 Tipe 2. (25%) with
duodenal ulcer
 Tipe 3. (15%) Prepilorik
to pyloric (2cm from
pyloric)
 Tipe 4. (5%) Proximal
abdomen/cardia

12. SIGN - SYMPTOM
 Gastric perforation -> acute peritonitis
 epigastrial pain -> Peritoneal irritation by HCL
 Peritoneal irritation -> defans muscular
 Decreased of bowel sound.

13. RADIOLOGICAL
Abdominal X-Ray (BOF, LLD,
Errect -> “FREE GAS SIGN”
air sickle sign, free air in
subdiafragma
CT Scan

14. CT

15. SURGICAL
1. Omental Patch
2. Parietal Sel Vagotomy :
a. Truncal Vagotomy
b. Selective Vagotomy
c. Highly selective vagotomy
3. Vagotomy and athrectomy
4. Vagotomy and Pyloroplasty

16. LAPAROTOMY
Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.
Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.

17. Omental Patch

18. Gastrojejunostomy

22. COMPLICATION
 EARLY:
Rebleeding
Gastric outlet
obstruction
Leakage / fistula:
-stump
-anastomosis
 LATE:
 Dumping syndrome :
 Early postprandial ->
30min
 Late postprandial -> 2-
3hours
 Ulcer reccurent
 Diarrhea postvagotomi ->
Lost of HCL bakteriosidal
 Gastritis bile refluks

23. PROGNOSA
Morbidity – Mortality : 5-10%
Procedure Mortality Reccurent Side effect
TV + A 0.6-1.8% 1-2% 13-29%
TV + drainase 0.5-1.4% 5-15% 11-26%
HSV 0.1-0.3% 5-16% 3-8%
Current surgical management of peptic ulcer, Surgical clinics of North America 2002

24. REFFERENCE
• Jacobs, L.M., Luk, S.S., 2010. Advanced Trauma Operative Management. 2nd ed. CineMed.
Canada.
• Kumar, et al. 2014. Robbins Basic Pathology. 9th ed. Elsevier. New York
• Mattox, et al. 2013. Trauma. 7th ed. Mc Graw Hill. New York.
• Sherwood L. 2008. Gaster Anatomy in Human Physiology From Cells to System. Seven Edition.
Brooks Cole. p. 636-639.
• Skandalakis L.J., 2014. Surgical Anatomy and Technique. 4th ed. Springer. New York
• Tortora G.J., Derrickson B.H. 2010. Principles of Anatomy and Physiology: The Digestive System.
Twelve Edition. Wiley. p. 134-136.
• Williams, N.S., Bulstrode, C.J., 2008. Bailey & Love’s Short Practice of Surgery. 25th ed. Hodder
Arnold. Great Britain
• Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.

25. Thank You